Common causes of fertility problems in men

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Could my partner have an fertility problem?

As a couple either one, or both, of you could have a fertility problem. If you and your partner have been making love regularly for more than a year without conceiving, make a joint appointment to see your doctor as a couple to find out whether there is a problem with either one of you.

If it turns out that your partner does have a fertility problem, he will not be alone. Would-be dads need help or treatment in 30 per cent of couples who are struggling to conceive (NCCWCH 2013:47).

What could be causing his fertility problem?

Blockages

Your partner may have a blockage in the ducts that carry his sperm. The blockage may be stopping his sperm from mixing with semen, ultimately preventing it reaching your egg. He may have the blockage as a result of an infection or injury. Or he may have been born with it.

Your partner is unlikely to know about the blockage. Once your doctor has decided that this is the likely cause of your problems, he'll probably recommend surgery to try to remove the block.

Your partner has a 50 per cent to 75 per cent chance of regaining his fertility after the blockage is cleared (NCCWCH 2013:136). And you have about a 25 per cent chance of becoming pregnant (NCCWCH 2013:136).

If you're under 35, your chances of becoming pregnant with ICSI and IVF are slightly better, at about one in three (HFEA 2012).

Irregular sperm

Maybe your partner has a low sperm count. Or perhaps his sperm are an unusual shape or not very mobile. Any of these factors will make it hard or impossible for his sperm to reach and fertilise your eggs.

Your partner won't know that he has a low sperm count or poor sperm mobility. But if tests reveal this to be the cause of your problems, your doctor may suggest:

gonadotrophins, a fertility drug that helps if your partner is not producing any sperm

If your partner decides to take gonadotrophins, there's a very good chance that he'll start to produce sperm again (Farhat et al 2010, NCCWCH 2013:134). Once that happens, you've got about a 40 per cent of chance of conceiving (Farhat et al 2010).

If you opt for IUI with donor sperm, and you're under 35, you have about a 15 per cent chance of success (HFEA 2012). ICSI is often the preferred assisted conception technique for male fertility problems, such as abnormal sperm.

Ejaculation problems

Your partner may be having trouble ejaculating. Perhaps he does not ejaculate at the right time. Or maybe his sperm "stays behind" or becomes flushed up into his bladder instead. This is called retrograde ejaculation.

Ejaculation problems can be psychological or physical. A spinal injury can cause ejaculation difficulties, as can conditions such as diabetes or, more rarely, multiple sclerosis.

This may be a highly sensitive issue for your partner, and he may be reluctant to talk about it. But do try to persuade your partner to discuss it with your doctor, as there are solutions. If he is experiencing retrograde ejaculation, there are fertility drugs that can stop that happening. If he has a mental block about erection or ejaculation, there are also drugs to help overcome that.

Your doctor may also suggest that you try vibratory stimulants to aid ejaculation. Another option is for your partner to have some sperm removed during surgery. This can then be used for an assisted conception treatment.

Drugs, or other treatments to treat infertility caused by retained or lost sperm, are generally successful. Encourage your partner by telling him that treatment can increase your chances of becoming pregnant, either spontaneously or with assisted conception, to around 80 per cent (NCCWCH 2013:137-8).

Varicoceles

If your partner has enlarged veins in his scrotum, they could be a sign of varicoceles. These big veins are like the varicose veins that can develop in other areas of the body. Varicoceles are common and may affect your partner's ability to produce sperm.

Encourage your partner to have a physical check-up at the doctor's. He'll be able to spot the enlarged veins even if your partner has not noticed them nor suffered any scrotal pain or heaviness.

Even if your partner does turn out to have varioceles, it's not clear exactly how they affect fertility, as not all men with varicoceles have a problem with their sperm. It could be that they warm up the testicles or reduce the space for sperm to be stored within the testicles. Surgery may improve his sperm count and quality, but it won't necessarily improve your chances of conception (Evers et al 2010, NCCWCH 2013:137). Ask your doctor about the latest treatment.

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